Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

Matos, Juliana Arruda de
Gomes, Amanda da Silva
Lima, Carla Ormundo G. Ximenes
Schmaltz, Carolina Arana Stanis
Oliveira, Cristiane Rocha de
Silva, Grasiela Martins da
Carijó, Julia Herkenhoff
Lopes, Marielena Aguiar
Morais, Quenia Cristina Dias
Brasil, Pedro Emmanuel Alvarenga Americano do
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The Brazilian Journal of Infectious Diseases
Background: There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI. Methods: We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software. Results: A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate). Conclusions: There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845. Keywords: Drug resistance, multiple; Gram-negative bacterial infections; Infection control; Surgical wound infection; Systematic review. Copyright © 2022 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.
Surgical wound infection, Infection control, Gram-negative bacterial infections, Drug resistance, multiple, Systematic review, Infecção da Ferida Cirúrgica, Controle de Infecções, Infecções por Bactérias Gram-Negativas, Resistência a Múltiplos Medicamentos, Revisão Sistemática
Matos JA, Gomes As, Lima COG, Schmaltz CAS, Oliveira CR, Silva GM, Carijó JH, Lopes MA, Morais QCD, Brasil PEAA. Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli. Braz J Infect Dis[Internet]. 2022;126(6):102705. doi: 10.1016/j.bjid.2022.102705.